Learn more about topical corticosteroids from dermatologist Dr. Cathryn Sibbald
Topical corticosteroids are a group of medications often used in the management of atopic dermatitis (AD), the most common form of eczema. To explore this topic further, Toronto-based dermatologist Cathryn Sibbald, MD, MSc, FRCPC, DABD, shared her expertise on topical corticosteroids and how they are typically used in treating AD.
What are topical corticosteroids?
Topical corticosteroids, sometimes just called ‘topical steroids’ or ‘steroids,’ are medicines commonly prescribed to quickly reduce inflammation, irritation, and itching in AD. They have been used for decades to treat various skin conditions and are applied directly to affected skin. They work by briefly changing the chemicals in the skin as a way to reduce inflammation. Corticosteroids are also made by the body naturally and help to control many body functions.
Topical corticosteroids have been used to treat eczema for more than 50 years and remain a first-line therapy for managing AD, meaning they are the first medication class prescribed for flares. Sometimes, instructions on how and when to use the medicine can be confusing. Unfortunately, there is no universal standard for topical steroids for AD patients. This confusion can lead to the medicine being used incorrectly, not using enough, and for not long enough. Talk to your health care provider (HCP) about what potency/strength, when to use, how much to use and when to stop using topical corticosteroids based on your AD.
Are there different strengths of topical corticosteroids?
The strengths of topical corticosteroids range from mild to very potent and can be prepared as creams, ointments, foams, lotions, or shampoos, depending on the area of the body being treated. Some patients prefer the feeling of applying a cream, while others find an ointment to be less likely to sting, although it can feel more greasy and thicker on the skin. Topical corticosteroids typically do not burn when they are applied to the skin. Foams and lotions can be helpful for hairy body areas and the scalp.
Less potent topical corticosteroids are available over the counter in Canada at pharmacies (i.e. without requiring a prescription from a doctor). More potent topical corticosteroids may be prescribed by your HCP. As with all medications, they should be used as per the prescriber’s instructions, and these are usually specific to where on the body they can be used and for how long.
Are side effects common?
Side effects related to topical corticosteroids are often seen with prolonged use of more potent steroids over time. It is important to remember that all medications have a risk of side effects, and untreated and under-treated AD can negatively impact different areas of life, such as sleep, mood, social activities, stress, ability to focus, and family life.
Additionally, without medicine on areas of AD, there is a risk of open areas not being treated quickly leading to risk of infection as well as risk of scarring.
Topical steroids should be discontinued when the skin is healed; however, it is essential to allow the skin to heal completely before stopping use. Discuss any questions or concerns regarding your treatment with a qualified health care professional.
Occasionally, your HCP may recommend a maintenance regimen where you apply the topical steroid twice weekly on areas of common flares to help decrease the flares. Your HCP should review with you the exact instructions for use in these cases.
In recent years, there has been an increase in social media attention around what is being called ‘topical steroid addiction’ or ‘withdrawal.’ While much is unknown about this phenomenon, some dermatologists who are researching this phenomenon believe it may be a rare side effect related to prolonged use of more potent topical corticosteroids, often on the face. Topical corticosteroids continue to be used frequently worldwide, are recommended in global guidelines, and can be used intermittently, for short periods, to quickly resolve skin inflammation.
Why do atopic dermatitis flares keep coming back?
AD is a chronic condition, meaning it may clear up for periods of time after treatment, but then it may flare up again. Due to the chronic or long-term nature of the condition, we focus on moisturizing the skin, avoiding triggers when and where possible, and treating flares at the first sign of inflammation (e.g., rash, redness, or itch) and until the skin is healed completely. Speak with a qualified HCP, such as a dermatologist, if your AD doesn’t go away after using topical corticosteroids and if you have any questions related to your/your child’s treatment plan. There is no cure for AD, but patients can achieve excellent control and live quite comfortably with existing medication.
Eczema Society of Canada thanks Cathryn Sibbald, MD, MSc, FRCPC, DABD, for her volunteer contribution to this educational content.
Disclaimer: Information provided in this resource does not constitute medical advice and is not intended to be used as a diagnostic tool. The information is up-to-date at time of publication. All medications, interventions, and treatment plans have risks and benefits, and it is important that individuals discuss their or their child’s specific health care needs with a qualified health care professional.
